發(fā)布時間：2018-01-19 02:33

  本文關(guān)鍵詞： 髂筋膜阻滯 蛛網(wǎng)膜下隙阻滯 髖置換關(guān)節(jié)成形術(shù) 歲以上老年人 喉罩麻醉　出處：《第二軍醫(yī)大學(xué)學(xué)報》2017年04期 　論文類型：期刊論文

【摘要】：目的回顧比較髂筋膜間隙阻滯(同時阻滯股神經(jīng)、股外側(cè)皮神經(jīng)和閉孔神經(jīng))復(fù)合喉罩全麻與蛛網(wǎng)膜下隙阻滯應(yīng)用于80歲以上人工股骨頭置換術(shù)患者(非骨水泥型)的優(yōu)劣性,探討適合骨科高齡患者的個體化麻醉方案。方法回顧性分析98例80歲以上人工股骨頭置換術(shù)患者的麻醉相關(guān)資料,其中髂筋膜間隙阻滯復(fù)合喉罩全麻44例(G組),蛛網(wǎng)膜下隙阻滯54例(S組),美國麻醉醫(yī)師協(xié)會(ASA)分級為Ⅱ~Ⅳ級。記錄麻醉誘導(dǎo)前以及誘導(dǎo)后5、10、15、20、30min時的平均動脈壓(MAP)和心率(HR),術(shù)前及術(shù)后即刻、術(shù)后6h、術(shù)后24h的疼痛視覺模擬評分(VAS);記錄麻黃堿使用次數(shù)、合并疾病、不良反應(yīng)發(fā)生情況、手術(shù)后住院天數(shù)及術(shù)前、術(shù)后1d睡眠質(zhì)量;調(diào)查手術(shù)醫(yī)生對麻醉方案的滿意度。結(jié)果兩組術(shù)前年齡、性別、體質(zhì)量指數(shù)等差異無統(tǒng)計學(xué)意義,G組患者ASAⅣ級例數(shù)多于S組(P0.05)。術(shù)后6、24h時G組VAS評分低于S組(P0.01),鎮(zhèn)痛效果滿意。兩組麻醉誘導(dǎo)前及誘導(dǎo)后不同時間點血流動力學(xué)差異無統(tǒng)計學(xué)意義;G組麻黃堿使用次數(shù)多于S組(P0.01),S組術(shù)后尿潴留的發(fā)生率高于G組(P0.05)。兩組手術(shù)后住院天數(shù)差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論對高齡髖關(guān)節(jié)置換患者需根據(jù)患者的具體情況選擇麻醉方案。在病例選擇適當(dāng)?shù)那闆r下,髂筋膜阻滯復(fù)合喉罩全麻與蛛網(wǎng)膜下隙阻滯相比術(shù)后鎮(zhèn)痛時間長,安全可行。
[Abstract]:Objective to compare the effect of iliofascial space block on femoral nerve block. Lateral femoral cutaneous nerve and obturator nerve) combined with laryngeal mask general anesthesia and subarachnoid block were used in patients over 80 years old in artificial femoral head replacement (non-bone cement type). Methods the anesthetic data of 98 patients over 80 years old with artificial femoral head replacement were analyzed retrospectively. Iliofascial space block combined with laryngeal mask general anesthesia was used in 44 cases of G group and subarachnoid space block in 54 cases of group S). The average arterial pressure (MAPP) and heart rate (HRR) were recorded before anesthesia induction and 30 minutes after induction. The visual analogue score of pain was assessed before and immediately after operation, 6 hours after operation and 24 hours after operation. The frequency of ephedrine use, associated diseases, adverse reactions, postoperative hospitalization days and sleep quality before operation and 1 day after operation were recorded. Results there was no significant difference in preoperative age, sex, body mass index between the two groups. The number of ASA 鈪，

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